124 Canine Sports Medicine and Rehabilitation
If a TrP is latent, it is nontender to palpation
and may persist. The presence of a TrP can
result in muscle tightness and/or weakness
leading to motor dysfunction (McPartland,
2004). Gordon and colleagues (2016) demon
strated decreased pain, increased flexibility,
and improved mobility with the use of TrP
release in patients with chronic shoulder pain.
Travell and Simons originally recommended a
TrP treatment technique similar to ischemic com
pression. However, after further research in the
late 1990s they modified their technique, recom
mending the use of gentle digital pressure. This
change in approach was based on what Travell
referred to as the “ATP energy crisis model.” This
model characterized a TrP as an area of tissue
hypoxia for which ischemic compression was
contraindicated (Simons et al., 1999). Their modi
fied technique was named “trigger point pres
sure release” (TTPR) and was based on the
“barrier‐release concept.” This technique uses
gentle digital pressure on the TrP, allowing the
practitioner’s finger to follow the releasing tissue
(McPartland, 2004). As the TrP tissue is released,
the digital pressure moves deeper into the TrP
until it is resolved. Deactivation of TrPs can also
be achieved with other techniques such as dry
needling, positional release therapy, spray and
stretch, and injection (McPartland, 2004). It
should be noted that further scrutiny of trigger
point theory and practice is ongoing and is neces
sary for a better understanding of the science
behind this phenomenon.
Positional release therapy (PRT), also referred to
as strain‐counterstrain (SCS), is a technique used
to treat tissue dysfunction (pain, tightness,
spasm). The technique was developed in the
1950s by Dr Lawrence Jones, an osteopathic phy
sician, who created a map of commonly occur
ring tender points throughout the body (Simons
et al., 1999). He believed that tender points were
associated with nerve root innervations
(Speicher, 2016). Jones proposed that PRT/SCS
inhibited the muscle spindle activation,
which decreases the amount of afferent impulses
to the brain and, thus, efferent impulses to
the same muscle. By interrupting this pathway,
the patient’s muscle is allowed to relax and
assume a normal resting tone (Kuchera, 2008).
Tender points were described as discrete areas of
tissue tenderness that can occur anywhere in the
body (Speicher, 2016). This is in contrast to a TrP,
which is a hyperirritable band of tissue. A tender
point is used diagnostically to indicate the loca
tion of the dysfunction (D’Ambrogio & Roth,
1997). PRT/SCS is a gentle, passive technique
that is generally well tolerated in acute, suba
cute, and chronic somatic dysfunction in people
of all ages (Speicher & Draper, 2006). The tech
nique consists of precise positioning of the body
part or joint such that the tissue is maximally
relaxed or shortened. While gently palpating the
tender point, positional micro‐movements or
“fine‐tuning” are performed until decreased ten
derness of the point is subjectively reported and
a reduction of firmness of the point is objectively
noted (D’Ambrogio & Roth, 1997). The position
is held for 60–90 s (3 minutes for the neurological
patient) after which the patient is slowly and
passively returned to the anatomically neutral
position without firing of the muscle spindle.
Additional manual techniques that are
outside the scope of this text but merit acknowl
edgement are as follows.
Myofascial release (MFR) addresses myofascial
connective tissue restriction with the intention
of eliminating pain and restoring motion.
Elongation of restricted fascial tissue is achieved
by applying a slow, low load (gentle pressure)
to the target viscoelastic medium (fascia). The
load is applied in three planes of motion using
either direct (into the direction of restriction) or
indirect (away from the direction of restriction)
techniques. This technique requires advanced
training from a therapist specializing in MFR.
Acupressure is based on the ancient healing
art of acupuncture. Using the same pressure
points and meridians, acupressure employs fin
ger pressure rather than needles to specific
points on the body.
Manual lymphatic drainage therapy (MLD)
focuses on specific lymph nodes and the natu
ral flow of the lymphatic system. Given that the
lymphatic system does not have its own pump
ing mechanism, MLD is intended to promote
free‐flowing lymphatic drainage. The technique
uses specific rhythmic hand strokes taught by
an MLD therapist.Treatment design
With knowledge of the above treatment tech
niques, one can determine which technique(s)
will most effectively address the patient’s issues
(Table 6.2). It is important that the underlying
cause or the root of the soft tissue abnormality